In the following section of this chapter, an overview of different hypnotherapeutic strategies and suggestions will be presented in relation to the different treatment phases (see Vanderlinden, Norre & Vandereycken, 1992).
Many obese patients are often very tense and have learned to reduce this tension through excessive eating. It is therefore useful to teach a self-hypnosis exercise for relaxation and as an alternative coping strategy for overeating. Patients will be strongly encouraged to practice their self-hypnosis daily by means of an audiocassette. To introduce hypnosis, we use a classical induction technique with eye fixation and deepening suggestions. Next, the patient will be asked to imagine herself in a safe, secret place, wherein she can become even more and more relaxed and further reflect upon the things in her (or his) life that are important right now.
Hypnotic techniques will be introduced to help the patient in gaining self-control over the eating pattern (Wright & Wright, 1987). The patient can be asked to identify situations wherein they lose control over their eating behavior. Usually, the bingeing behavior will take place in specific situations. Hence a suggestion will be made for the patient to identify the triggers (either internal, such as a mood state or external, such as the availability of food) that may provoke their bingeing behavior and be taught new strategies for control.
During hypnosis, suggestions can be made, for instance (see also Coman & Evans, 1995):
1. To reduce food quantity.
2. To eat at fixed times and places.
3. To observe their diet rigorously.
4. To restrict the purchase of food supplies.
5. To evoke aversive responses, such as sickness and disgust, when eating high-calorie food.
Most obese people have eating habits that differ strongly from those of normal weight people. They often eat almost automatically, half-consciously and very quickly. Teaching how to return to normal eating habits is therefore an important part of the treatment. This can first be taught during hypnosis. Patients are asked to imagine they are sitting quietly at a table, enjoying their meal slowly, bite after bite, to be chewing the food slowly in their mouth and enjoying the various flavors. At the same time, post-hypnotic suggestions can be made to eat quietly at home as well. This way, eating can become an art: the patient will enjoy food more and more, and eating can again become a pleasurable activity.
After hypnosis induction, the patient can be asked to describe the food that lies on the table and how it smells. Next, the following suggestions can be given:
And when your stomach is signaling you that you are hungry, first decide what you are going to eat and how much ... OK now you can take your first bite and try to concentrate on what you are tasting. Maybe you'll discover all kind of new flavors during your breakfast. Try to eat as slowly as possible and hence you may learn to enjoy eating much longer than ever before ... And bite after bite, you may become more and more aware how nice it is to eat slowly, while concentrating more and more on all the sensations in your body ... All the different flavors and odors ... And when your stomach signals to you that it is filled with food, you can become aware of an ever increasing feeling of fulness in your stomach, so that you can stop eating and be pleased with yourself, completely satisfied until your next meal and pleased with this very new experience ...
Obese patients often have to be made conscious again of feelings of hunger and satiation, which can be suggested and taught systematically during the trance. After hypnosis induction, the patient can be asked to concentrate on the feelings in her stomach. Suggestions can be given on how the stomach can communicate to the patient that it is empty, or when it is full and satiated. Other suggestions may be: 'Hunger will help me to signal when it is time to eat my meal, and the feeling of hunger will help me to enjoy my meal. And while enjoying my meal, I will develop a better contact with my stomach, I can concentrate on the feelings in my stomach and become aware with every bite I take, how my stomach tells me that it is filled with food...'
Since physical exercise to increase metabolism is of crucial importance for promoting weight loss, the patient will receive a suggestion to start with more and regular movement during a hypnosis exercise. After hypnosis induction the patient is asked to imagine that she is for instance riding a bicycle. While cycling, suggestions are given to become more and more relaxed, reaching a deeper state of trance and/or relaxation. This exercise aims also to motivate the patient to start cycling (with a home-trainer) in the actual situation at home.
An alternative to the classical induction technique is active-alert hypnosis (Banyai, Zseni & Tury, 1993). In this method the hypnotic subject rides a bicycle ergometer (home-trainer) with eyes open throughout the whole hypnotic session. While cycling, verbal suggestions are given to enhance alertness, attentiveness and a feeling of freshness. This exercise combines different goals: increasing actual metabolism, learning to relax while cycling and enhancing motivation for doing physical exercise. For several years active-alert hypnosis on a bicycle has become a basic strategy in our treatment of obesity.
When the patient starts pedalling on the bicycle, the following suggestions can be given:
And now that you have started pedalling, you can listen to my voice and concentrate on all the sensations in your body ... And while you are pedalling continuously, you can become more and more aware of the rhythmic movement of your muscles, especially your legs. Try to concentrate more and more on the rhythmic movement of your legs, ... Maybe you will notice how this movement, the pedalling, will become more and more automatic, how cycling becomes easier. After a while you will maybe notice how your legs perform the pedalling more and more easily, you will be able to pedal the bicycle in a more relaxed fashion, easily and automatically. The physical exercise can increase your metabolic rate and help you to burn your calories ... And the more you cycle, the more you may have the feeling as if your legs become independent of your body. Your legs move automatically ... And while you are breathing in the fresh air, your head can feel lighter and clearer, you can concentrate more and more easily, and start to feel more and more relaxed ... and become aware more and more of your inner resources ...
In only a small number of patients will teaching self-control and relaxation succeed in helping them to change their eating behavior and weight. In most of the obese patients we are working with, the uncovering and exploring of the meaning or function of obesity in the patient's past and present life situation is of crucial importance. This may reveal issues we have to deal with in the following phase.
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Hypnosis is a capital instrument for relaxation and alleviating stress. It helps calm down both the brain and body, giving a useful rest. All the same it can be rather costly to hire a clinical hypnotherapist, and we might not always want one around when we would like to destress.